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J R Soc Med. 1983 September; 76(9): 755–759.
PMCID: PMC1439402

Towards the effective use of diagnostic radiology in surgical practice: discussion paper.


This paper takes as an example of the cycle of evaluation the work of the Royal College of Radiologists in connection with the more effective use of preoperative chest X-ray. The work covers a six year period beginning with an observation of practice on a national sample in 1976, progressing to the comparison of existing practice with expectations in 1978. This was followed by the development of guidelines of practice which were disseminated informally, and formally through scientific papers and meetings from 1979. In 1981, practice was again observed in a pilot area to ascertain if the proposed guidelines had produced the desired affect. The results of this second review showed that the intentions of the guidelines had been achieved successfully, i.e. substantial reduction in utilization with considerable potential financial saving without any decrease in the original effectiveness or safety of the intervention. Thus this example shows the closing of the evaluation loop and the successful implementation of change.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Bengtsson G, Blomgren PG, Bergman K, Aberg L. Patient exposures and radiation risks in Swedish diagnostic radiology. Acta Radiol Oncol Radiat Phys Biol. 1978;17(2):81–105. [PubMed]
  • Nelson AR. Orphan data and the unclosed loop: a dilemma in PSRO and medical audit. N Engl J Med. 1976 Sep 9;295(11):617–619. [PubMed]
  • Rees AM, Roberts CJ, Bligh AS, Evans KT. Routine preoperative chest radiography in non-cardiopulmonary surgery. Br Med J. 1976 May 29;1(6021):1333–1335. [PMC free article] [PubMed]
  • Roberts CJ. Medical care as a risk-avoidance procedure: underwriting the cost of care in the UK. Br Med J (Clin Res Ed) 1982 Sep 11;285(6343):751–755. [PMC free article] [PubMed]

Articles from Journal of the Royal Society of Medicine are provided here courtesy of Royal Society of Medicine Press